Provider Demographics
NPI:1235941220
Name:CONDIE, TAMRA RAE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TAMRA
Middle Name:RAE
Last Name:CONDIE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 E PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-4524
Mailing Address - Country:US
Mailing Address - Phone:801-254-4600
Mailing Address - Fax:
Practice Address - Street 1:1420 W 12600 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7070
Practice Address - Country:US
Practice Address - Phone:801-254-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9132121-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily